Fracture appliance



FRACTURE APPLIANCE Filed Jan. 15, 1952 IN VEN TOR.

ATTORNEYS Patented Oct. 6, 1 936 UNITED STATES PATENT OFFICE 6 Claims.

The present application relates to a fracture appliance, and more particularly to apparatus for skeletal control of bone fragments during reduction, treatment, and healing of injuries to the soft parts and consolidation of the bone; and during the application of any other internal or external splint or means of fixation. The appliance may be termed a bone-setting splint. It is an object of the present invention to provide a device which shall be capable of use to apply the necessary tension to a fractured limb to elongate the same, whereby the reflex action of the muscles will be overcome and the fractured bone will be moved to a position in which the fractured ends thereof are in proper position with relation to each other. It is a further object of the invention to provide mechanism of the character described which shall be capable of substantially universal adjustment to compensate for angulation and for rotation of the injured parts caused, usually, by reflex action of the muscles of the limb, the force of the injury and/or by the effect of gravity. It is a further object of the invention to provide mechanism of the character described which shall be capable not only of actuation to set the fractured bone, but also of holding the bone fragments, once set, in proper relation with respect to each other for an indefinite period, whereby the use of splints, casts, and other similar means is obviated. Still another object of the invention is the provision of mechanism of the character described which shall be capable of positioning, and of holding in position, a plurality of small fragments which may have been broken away from the main portions of a fractured bone. Further objects of the invention will appear as the description proceeds.

The device of the present invention is particularly adapted for use in connection with fractures of the bones of the upper and lower leg, and of the forearm. In practically all instances of such fractures, the muscular action of the limb causes contraction of the limb, whereby the fractured ends of the bone are overlapped. In many instances, the limb is bent at the point of fracture, and quite often the outermost fragment of the bone is rotated about its axis by muscular action, or otherwise. The first step in treating such a fracture is to elongate the limb, whereby the fractured bone ends are moved apart. The limb must then be straightened, and the free end thereof must be rotated about its axis to compensate for the abnormal rotation thereof. Thereafter, the tension upon the free end of the limb is relaxed somewhat, whereby the bone ends are permitted to return to contact with each other under muscular action, the surgeon gently manipulating the free end of the limb during such movements to effect absolutely mating registration at the fracture.

Particularly in the case of leg fractures, the amount of force which must be applied to separate and re-align the bone portions is considerable; and when manual manipulation is solely relied upon, improper re-alignment very often results. It is also to be noted, after the bone has been set, even though the setting may have been perfect, the bone must be held absolutely still during the application of a splint or a cast to the limb; and when a surgeon relies solely upon manual assistance, the bone often becomes misplaced before the application of the splint or cast can be completed.

Furthermore, it often occurs in severe cases of crushing fractures that small pieces of the bone are broken loose from the two main sections.

Obviously, relocation of such fragments by man- 2 -ual manipulation is very difficult, and it is still more diflicult to hold those fragments in place during the application of a splint or cast. Even when such fragments are properly located initially, and even when it is possible to hold them in place during the application of the splint or cast, it often happens that such a fragment or fragments will become misplaced even while the patient is wearing the cast or splint.

The apparatus of the present invention greatly facilitates the manipulation of the bone portions to bring the same into proper mating alignment and relation, since it eliminates all purely manual manipulation; and said apparatus further obviates the necessity for the use of a cast or strapped splint, since it. may be allowed to remain upon the injured limb during the knitting period. Still further, the apparatus of the present invention includes means applicable directly to the bone closely adjacent to the point of fracture for holding the bone portions in desired relation; and further includes means directly applicable to fragments of the character above mentioned, to hold the same rigidly in desired relationship with the remainder of the bone.

To the accomplishment of the above and related objects, my invention may be embodied in the form illustrated in the accompanying drawing, attention being called to the fact, however, that the drawing is illustrative only, and that change may be made in the specific construction illustrated and described, so long as the scope of the appended claims is not violated.

Fig. 1 is a plan view of a leg having a fractured bone therein, with the apparatus of the present invention applied thereto;

Fig. 2 is a perspective view of an embodiment of the present invention;

Fig. 3 is a sectional view through a leg showing the method of application of the apparatus to the fractured bone; and

Fig. 4 is an enlarged fragmental vertical sectional view taken substantially in the plane of the axis of the threaded base.

Referring more particularly to the drawing, it will be seen that I have illustrated an apparatus comprising a threaded rod I provided with a longitudinally extended kerf II therein. One end of said rod is received in a clamping sleeve I2, and the opposite end of said rod is received in a similar clamping sleeve I3, said sleeves I2 and I3 being provided with foot pieces I4 and I5, respectively. Each sleeve I2 and I3 is formed as a split tube, and each of said sleeves is provided with a pair of ears I6 with which cooperates a bolt I1 for clamping the sleeve in place on the rod I0. Each sleeve is further provided with a screw I8 projecting therethrough and adapted to be projected into the kerf II; and with a set screw I9 adapted to be turned down onto the rod I0, still more securely to attach the sleeve to the rod.

Slidably mounted upon the rod I0 between the sleeves I2 and I3 is a clamp 20 comprising a split tube provided with laterally extending ears 2| with which cooperates a bolt 22 for clamping said tube 26 in position upon the rod I9. tube 20 is provided with an interiorly projecting tongue 90 which engages in the kerf II to prevent rotation of the clamp about the axis of the rod. Said clamp 29 carries a horizontally disposed platform 23 which, in turn, carries a substantially vertically projecting pivot pin 9|. Mounted upon the platform 23 and for oscillation about the pivot pin is a base 24 provided with an arcuate slot 25 therein in which is received a pin or bolt 26 detachably secured to the platform 23. It will be obvious that the base 24 is oscillable upon the platform 23, and that the bolt 26 may be turned down to clamp said base 24 in any desired position.

The base 24 carries a bracket 21 of U-shaped cross section, said bracket being provided with a pair of substantially parallel rollers 28, said rollers being journalled in the upstanding walls of said bracket 21.

A U-shaped saddle 29 is adapted to be received in the bracket 21 and to rest upon the rollers 28, said saddle being held in the substantially vertical plane illustrated by the side walls of the bracket 21. At each of its free ends, the saddle 29 is rabbeted, as at 30, to form a notch receiving the squared head 3| or 32 of one of a pair of bolts 33 and 34, said bolts passing through the ends of the saddle 29 and receiving nuts on their projecting ends, whereby said heads may be drawn up tightly against the ends of the saddle 29.

Each of the bolts 33 and 34 is provided with a transverse bore 35 adapted to receive a drill 36 which is preferably formed of steel wire, which is sharpened at its one end to form a drilling bit, and which is of a cross section substantially equivalent to ordinary piano wire.

The saddle 29 is removably secured in place in Said the bracket 21 by a bolt 31 which projects through suitably formed apertures in the upstanding walls of said bracket and which, when in position, overlies the saddle 29. The nut carried by the bolt 31 may be turned up to draw the free ends of the upstanding walls of the bracket 21 toward each other, to clamp the saddle 29 in any desired adjusted position.

A second clamp 38 is slidably mounted upon the rod I0, said clamp 38 being similar to the clamp 29 in all respects. Said clamp 38 is formed with a pair of ears 39 with which cooperates a bolt 40 which may be operated to clamp the member 38 to the rod I0. Said clamp 38 likewise is provided with an interiorly projecting tongue (not shown but identical with the tongue 90) engaging in the kerf II.

The clamp 38 carries a platform 4I providing an upstanding pivot pin (not shown but identical with the pin 9I upon which is oscillably mounted a base 42 provided with an arcuate slot 43 with which cooperates a bolt or pin (not shown) similar to the bolt or pin 26. Said base 42 carries a bracket 44 similar in all respects to the bracket 21 and provided with a pair of rollers 45 upon which rests a second saddle 46 similar in all respects to the saddle 29. The free ends of said saddle 46 are rabbeted as at 41 to receive the squared heads 48 and 49 of a pair. of bolts 50 and transversely bored to receive the'drill 52 similar in all respectsto the drill 36. A bolt 53 cooperates with the bracket 44 to retain said saddle 46, and to hold the same in adjusted positions.

A nut 54 is threadedly mounted on the rod ID and is cooperable with the clamp 38 to move said clamp gradually away from the clamp 20, and to hold said clamp 38 against movement toward said clamp 20.

It will be seen that the saddles 29 and 46 are oscillable about centers which lie at the centers of curvature of said respective saddles; and it will further be apparent from an inspection of the drawing that the axis of oscillation of each saddle lies substantially in the same vertical plane with the axis of a bone centrally mounted on the drill 36 or the drill 52, respectively, and is normally non-angularly related to such bone axis.

The apparatus of the present invention comprises also any desired number of units such as those illustrated at 56 and 51. Each of such units comprises a clamp provided with cars 58 with which cooperates a bolt 59 for clamping the unit. in desired position on the rod I0, said clamps being slidably mounted upon the rod and being, provided with inwardly projecting tongues (not shown) engaging in the kerf II. Unit 56 comprises a bracket 69 similar in all respects to the brackets 21 and 44 and providing rollers 6| upon which rests an arcuate arm 62, a bolt 63 being projected through the upstanding walls of the bracket 60 to retain the arm 62, and to clamp the same in desired position.

At one end, the arm 62 is provided with a recess in which is received the cylindrical shank 64 of a member 66, said shank being rotatable in its socket, and the arm 62 being provided with a set screw 65 for holding said shank in desired adjusted position. With the member 66 there is associated an element 61, said element being oscillably mounted upon said member 66 through the medium of a bolt 68, and said element 61 carrying a guide tube 69 in which is rotatably and reciprocably mounted a drill 10, said drill 75 19 preferably being screw-threaded adjacent its sharpened end. A set screw H is provided to hold the drill 10 in adjusted position within the tube 69. It will be seen that the arm 62 may be moved upon the rollers BI to shift the position of the drill l0; and that the rotatable shank 64 and oscillable member 61 provide for universal adjustability of the guide 69 and drill '10.

The unit 51 comprises a clamp carrying a bracket 12 identical with the bracket 60, together with an arm '53 identical with the arm 62, and having mounted thereon through the medium of mechanism identical with the elements 64, 65, 66, 61, and 68, a guide tube 14 in which is mounted a drill 75 identical with the drill 10, said tube 14 being provided with a set screw 16 for holding the drill 15 in adjusted position.

The use of the disclosed apparatus is as follows: Assuming that the patients leg 11 is fractured in the manner illustrated at 80, and that a fragment 82 hasbeen broken off from the portion 79 of the bone, as at 3|, and assuming that the bone portions 18 and 19 have overlapped, and have been bent out of alignment, and that the portion 19 thereof has been rotated about its axis, the first step of the surgeon equipped with apparatus of the character described herein is to anaesthetize the limb, and drive the drill 35 through the soft parts of the limb and through the portion 18 of the bone. He then similarly drives the drill 52 through the soft parts of the limb and through the portion 19 of the bone. Thereafter, the bolts 33 and 34 are threaded onto the drill 35, the saddle 29 is positioned to embrace the limb, and the bolts 33 and 34 are engaged in the apertures formed in the free ends of said saddle 29. Preferably, after the bolts 33 and 34 have been entered in said apertures, and before the heads 3| and 32 thereof have engaged the shoulders 39 of the saddle 29, said bolts are rotated in opposite directions through ninety degrees, whereby the drill 36 is crimped, and whereby a desired longitudinal tension is placed upon said drill. The nuts upon the bolts 33 and 34 are then turned up, whereby the drill 36 is securely clamped between the ends of saddle 29 and the heads 3| and 32 of the bolts 33 and 34.

The saddle 45 is then similarly associated with the drill 52, longitudinal tension being desirably applied to the drill 52. It will be obvious that the application of this longitudinal tension to the drills 33 and 52 will materially reduce the tendency of said drills to. bend as tension is applied therethrough to the patients limb.

After the saddles 29 and 46 have been associated with the drills 33 and 52, the rod l3, carrying the clamps 25 and 38 and the elements associated therewith, is placed beneath the limb, and the saddles 29 and 45 are associated with their respective brackets 2'! and 44. Angulation of the limb is compensated by adjustment of the bases 24 and 42 about their vertical pivots. Since the drills 36 and 52 are preferably driven through the limb in such a position that, when the toes of the patient are pointing upwardly, said drills will lie in a substantially horizontal plane, and since the portion 19 of the bone is assumed to have been rotated, it will be obvious that the saddle 46 will necessarily be canted from the position illustrated in Fig. 2 when the same is first associated with the bracket 44.

After the saddles 29 and 46 have been entered in the brackets 2'! and 44, the bolts 31 and 53 are positioned in said brackets, and the bolt 31 may be turned up toclamp the saddle 29 in position. The bolt 26 is permitted to remain loose, as is also the corresponding bolt associated with the base 42.

The nut 54 is now rotated to enforce movement of the clamp 38 away from the clamp 20, said clamp 20 being tightly clamped to the rod ID to prevent movement thereof. If desired, a Wrench may be associated with the sockets 55 of the nut 54 to assist in the rotation of said nut. It will be seen that any desired degree of tractive effort may be applied to the limb by the nut 54, and that elongation of the limb may be effected as gradually or as rapidly as may be desired. During such elongation, the surgeon may be manually manipulating the fractured bone ends by oscillation of the bases 24 and 42 to compensate for angulation, and by oscillation of the saddle 46 in its bracket 44 to compensate for rotation of the bone portion 19.

When the bone ends have been satisfactorily separated, the nut 55 may be gradually backed away, whereby the clamp 38 and its associated elements will be permitted to move gradually toward the clamp 25. The fractured bone ends are thus permitted to approach each other gradually, the surgeon meantime manipulating the limb to prevent the entry of soft parts between the approaching bone ends, and to insure proper mating relation of the fractured bone ends. When the bone ends have been brought into the desired relation in this manner, the bolt 26 and the corresponding bolt associated with the base 42 may be turned down to clamp the bases 24 and 42 against further oscillation, and the bolt 53 may be turned up to clamp the saddle 46 against further oscillation.

If, now, it appears to the surgeon to be necessary or advisable to provide means closely adjacent the fracture for holding the bone ends against dislocation, two or more of the units such as 55 and 5'! may be associated with the mechanism. The universal adjustment provided permits the surgeon to locate his drills in any desired positions, and to drive the drills confidently and accurately into the bone. In Fig. 1, I have shown the drill l5 driven into the portion 18 of the bone immediately above the fracture I have shown the drill driven, from the other side, into the portion 19 of the bone immediately below the fracture; and I have shown the drill Ill driven into the fragment 82 to hold the same in position.

The drill 85 is carried in a guide tube 84 associated with an arm 83 in exactly the manner in which the guide 69 is associated with the arm 62.

It will be obvious that, when the surgeon has completed the operations above described, all portions of the fractured bone will be absolutely rigidly held in desired relationship so long as no further adjustments are made in the'described apparatus. It is sometimes necessary or desirable, however, to manipulate the limb somewhat during the knitting process, and the wide range of adjustability built into the disclosed apparatus permits any such desired manipulation.

An important feature of the present invention lies in the fact that there is no clamping or binding engagement of the apparatus with the bone or with the soft parts of the limb at any point. Another feature lies in the fact that the limb is maintained absolutely open, whereby the surgeon has free access to the limb during the knitting process. Thus, treatment of contusions or lacerations during the process of bone knitting is facilitated, and irritation of the soft parts of the limb is substantially eliminated.

Often fractures are accompanied by severe bruises of the soft parts of the limb, and the application of tight straps or metal clamps, or the application of a plaster cast results in severe and unnecessary suffering to the patient. Furthermore, the application of such straps or clamps often results in necrosis and sloughing of the soft parts, particularly when the injury has been such that, in itself, it has a tendency to retard circulation. The present apparatus eliminates the necessity for such treatment. Contusions and lacerations may give rise to serious results if the limb is enclosed in a plaster cast for a. period of many days, particularly if any infection happens to have set in. Such complications are, of course, obviated by the present apparatus.

It very often happens that, in cases of fracture, the limb swells very rapidly and to very great size. The application of a plaster cast or of an ordinary splint to a swollen limb is practically impossible because of the fact that, as the swelling disappears, the cast becomes loose and its effectiveness is destroyed. A swollen condition or a reduction thereof will, of course, have no effect upon the apparatus of the present application.

It will thus be seen that I have provided a highly efficient apparatus for accomplishing the desired results, and that said apparatus overcomes many difficulties which have heretofore faced'a surgeon dealing with a complex fracture.

I claim as my invention:

1. A bone-setting splint comprising a base, a pair of drills adapted to be driven through the bone of a fractured limb, a pair of elements mounted on said base and rigidly engaging said drills, means cooperating with said base and with one of said elements for separating said elements to effect elongation of said limb, at least two brackets adjustably mounted on said base, an arcuate arm adjustably mounted in each of said brackets, a guide adjustably carried at the free end of each arm, and a drill mounted in each of said guides, whereby said drills are universally adjustably mounted on said base, said drills being projectable into said bone above and below a fracture therein to hold the] same in desired position.

2. A device for setting and holding fractured bones which comprises a base, universally adjustable bone-engaging means mounted on said base for effecting separation and setting of the fractured bone ends, said means including drills adapted to be driven through the bone, and other universally adjustable bone-engaging means mounted on said base for holding said bone ends in desired relation, said other means including drills adapted to be driven into the bone.

3. In combination, a threaded rod, a clamp slidably mounted on said rod and carrying a substantially vertical pivot, a bracket mounted on said clamp for oscillation about said pivot, a saddle removably mounted in said bracket, a second clamp slidably mounted on said rod and carrying a second substantially vertical pivot, a second bracket mounted on said second clamp for oscillation about said second pivot, a second saddle removably mounted in said second bracket, bone-engaging means carried by each of said saddles, and a nut threadedly mounted on said rod and cooperable with one of said clamps to enforce movement thereof.

away from the other of said clamps.

4. In combination, a threaded rod, a clamp slidably mounted on said rod and carrying a substantially vertical pivot, a bracket mounted on said clamp for oscillation about said pivot, a pair of rollers mounted on parallel axes in said bracket, a saddle resting on said rollers, means removably securing said saddle in place on said rollers, a second clamp slidably mounted on said rod and carrying a second substantially vertical pivot, a second bracket mounted on said second clamp for oscillation about said second pivot, a second pair of rollers mounted on parallel axes in said second bracket, a second saddle resting on said last-mentioned rollers, means removably securing said second saddle in place on said last-mentioned rollers, boneengaging means carried by each of said saddles, and a nut threadedly mounted on said rod and cooperable with one of said clamps to enforce movement thereof away from the other of said clamps.

5. In combination, a threaded rod, a clamp slidably mounted on said rod, an arcuate member carried by said clamp and disposed in a plane substantially perpendicular to said rod, said arcuate member being oscillable in its own plane about an axis disposed within the area bounded by said arcuate member, a second clamp slidably mounted on said rod, a second arcuate member adjustably and removably carried by said second clamp, bone-engaging means carried by each of said arcuate members, and a nut threadedly mounted on said rod and cooperable with one of said clamps to enforce movement thereof away from the other of said clamps.

6. In a fracture appliance, a drill supporting member including two spaced arms, means associated with one of said arms for engaging and holding one end of a drill, and clamping means associated with the other of said arms for engaging and holding the other end of said drill, said clamping means including a headed bolt received in and passing through an aperture formed in said arm, and a nut received on'the projecting end of said bolt and rotatable to clamp said bolt head against said arm, said bolt being formed, intermediate said head and said arm, with a transverse bore through which a portion of said drill extends, whereby rotation of said bolt will crimp said drill and apply longitudinal tension thereto.

ALBERT A. THOMAS. 

